Association of goals of care meetings for hospitalized cancer patients at risk for critical care with patient outcomes.

Autor:	Apostol CC; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (SKCCC), Baltimore, MD, USA apostco@jhmi.edu., Waldfogel JM; Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA., Pfoh ER; Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., List D; Department of Social Work, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (SKCCC), Baltimore, MD, USA., Billing LS; Harry J. Duffey Family Pain and Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (SKCCC), Baltimore, MD, USA., Nesbit SA; Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA., Dy SM; Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Harry J. Duffey Family Pain and Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (SKCCC), Baltimore, MD, USA.
Jazyk:	angličtina
Zdroj:	Palliative medicine [Palliat Med] 2015 Apr; Vol. 29 (4), pp. 386-90. Date of Electronic Publication: 2014 Dec 19.
DOI:	10.1177/0269216314560800
Abstrakt:	Background: Caring for cancer patients with advanced and refractory disease requires communication about care preferences, particularly when patients become ill enough to be at risk for critical care interventions potentially inconsistent with their preferences. Aim: To describe the use of goals of care discussions in patients with advanced/refractory cancer at risk for critical care interventions and evaluate associations between these discussions and outcomes. Design: Cohort study describing patients/families' perceptions of goals of care meetings and comparing health care utilization outcomes of patients who did and did not have discussions. Setting/participants: Inpatient units of an academic cancer center. Included patients had metastatic solid tumors or relapsed/refractory lymphoma or leukemia and were at risk for critical care, defined as requiring supplemental oxygen and/or cardiac monitor. Results: Of 86 patients enrolled, 34 (39%) had a reported goals of care discussion (study group). Patients/families reported their needs and goals were addressed moderately to quite a bit during the meetings. Patients in the study group were less likely to receive critical care (0% vs 22%, p = 0.003) and more likely to be discharged to hospice (48% vs 30%, p = 0.04) than the control group. Only one patient in the study group died during the index hospitalization (on comfort care) (3%) compared with 9(17%) in the control group (p = 0.08). Conclusion: Goals of care meetings for advanced/refractory cancer inpatients at risk for critical care interventions can address patient and family goals and needs and improve health care utilization. These meetings should be part of routine care for these patients. (© The Author(s) 2014.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu